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Placental histopathology associated with preeclampsia: A systematic review and Meta-Analysis.

Falco, ML; Sivanathan, J; Laoreti, A; Thilaganathan, B; Khalil, A (2017) Placental histopathology associated with preeclampsia: A systematic review and Meta-Analysis. Ultrasound Obstet Gynecol, 50 (3). pp. 295-301. ISSN 1469-0705 https://doi.org/10.1002/uog.17494
SGUL Authors: Thilaganathan, Baskaran Khalil, Asma

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Abstract

OBJECTIVES: Preeclampsia is associated with impaired trophoblast invasion and typical villous and vascular placental lesions. The primary aim was to conduct a systematic review in order to quantify the prevalence of placental histopathological lesions in pregnancies complicated by preeclampsia. METHODS: MEDLINE, EMBASE and CINAHL were searched electronically and relevant articles reporting placental histopathological lesions were assessed according to the following criteria: study design, number of pregnancies, type of preeclampsia and whether the pathologist was blinded to the clinical information. Prospective and retrospective case-control studies, including 100 pregnancies or more in total, were included. The number of the most prevalent histological lesions according to the Perinatal Section of the Society for Pediatric Pathology classification was extracted and categorized in two main groups, "villous lesions" and "vascular lesions". Random-effect meta-analysis of proportions was used for analysis. Between-study heterogeneity was assessed using the I(2) statistic. RESULTS: The search yielded 717 citations and a total of 8 studies were included in the review. In unblinded studies, the pooled prevalence of villous lesions was 11.6% (95% CI 6.4-18.1%) and 48.2% (95% CI 19.1-77.9%) in normal and preeclamptic pregnancies, giving a pooled odds ratio (OR) of 7.59 (95% CI 2.16-26.62). In blinded studies, the pooled prevalence of villous lesions was 18.5% (95% CI 1.4-48.7%) and 42.0% (95% CI 13.3-74.2%) in normal and preeclamptic pregnancies, giving a pooled OR of 4.28 (95% CI 1.16-15.76). In unblinded studies, the pooled prevalence of vascular lesions was 8.1% (95% CI 4.5-13.2%) and 37.3% (CI 3.1-82.4%), giving a pooled OR of 20.34 (95% CI 11.53-35.89). In blinded studies, the pooled prevalence of vascular lesions was 9.8% (95% CI 0.7-27.8%) and 38.9% (24.1-54.8%), giving a pooled OR of 7.08 (95% CI 2.55-19.61). CONCLUSIONS: The prevalence of both placental villous and vascular histopathological lesions is higher, by a factor of four to seven-fold, in preeclampsia compared to normal pregnancies in blinded studies. Greater differences are reported in unblinded studies. Despite the fact that the probability (point prevalence) of finding abnormal placenta pathology is higher in preeclampsia, placental lesions are not specific to the diagnosis of preeclampsia.

Item Type: Article
Additional Information: This is the peer reviewed version of the following article: Falco, M. L., Sivanathan, J., Laoreti, A., Thilaganathan, B. and Khalil, A. (2017), Placental histopathology associated with pre-eclampsia: systematic review and meta-analysis. Ultrasound Obstet Gynecol, 50: 295–301, which has been published in final form at http://doi.org/10.1002/uog.17494. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.
Keywords: Preeclampsia, histology, pathology, placenta, vascular lesions, villous lesions, Obstetrics & Reproductive Medicine, 1114 Paediatrics And Reproductive Medicine
SGUL Research Institute / Research Centre: Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Academic Structure > Molecular and Clinical Sciences Research Institute (MCS) > Vascular (INCCVA)
Journal or Publication Title: Ultrasound Obstet Gynecol
ISSN: 1469-0705
Language: eng
Dates:
DateEvent
5 September 2017Published
23 April 2017Published Online
10 April 2017Accepted
Publisher License: Publisher's own licence
PubMed ID: 28436167
Go to PubMed abstract
URI: http://openaccess.sgul.ac.uk/id/eprint/108809
Publisher's version: https://doi.org/10.1002/uog.17494

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